Midterm 1 Flashcards
Definition of Chronic Disease
A physical or mental health condition that lasts more than 1 year, requires ongoing treatment/management and causes functional restrictions (Social, physical, cognitive)
6 Key features of chronic disease
Long duration Not curable Not communicable Slow progression Does not disappear on its own Gets worse with time
How does ageing affect chronic disease prevalence?
With age, chronic disease becomes increasingly prevalent. The prevalence of individuals with multiple CDs also increases.
What is the most common limitation caused by CDs?
Physical limitations.
Why is exercise high risk high reward for CD management?
Exercise can be highly beneficial but also has an enhanced ability to do harm in those with CDs compared to those without CDs.
3 levels of intervention utility
1) treats the disease
2) manages symptoms
3) general health
What does PICOS stand for?
Population Intervention Comparison Outcome Study design
What is clinical equipoise?
Genuine uncertainty among clinicians on if the intervention will be benficial.
What is the parallel universe concept of RCTs?
By using randomization to create two groups, these groups can be thought of as parallel universes where the only differences between them are due to the intervention.
Uncertainty Principle
Clinicians who are convinced, by evidence, that one intervention is beneficial can not ethically randomize patients. They must be uncertain about the intervention.
What is a primary endpoint?
A primary endpoint is the main variable of interest and is usually related to the disease and its symptoms.
Two important steps in randomization…
1) The allocation sequence is truly random and follows no pattern.
2) Recruiters are not aware of which group the person they are recruiting will be assigned to.
Controlled clinical trials include…
RCTs and nonrandomized control trials.
What four groups can be blinded?
1) Participants
2) Interventionists
3) Assessors
4) Data analysts
What does a classic double-blind study include?
Participants and interventionists blinded.
What should be done when data is missing due to dropouts or protocol violations?
Conduct an intention-to-treat (ITT) analysis.
What are carcinomas?
Cancers developing from epithelial cells
What are sarcomas?
Cancers developing from soft tissues (muscle, tendon, ligaments) and bone.
Leukemias?
Cancers developing from blood-forming tissue in bone marrow
Lymphomas?
Cancers developing from lymphocytes in lymph system (immune cells)
What causes cancers?
Inherited gene mutations account for 5%, environmental factors (smoking, UV) account for 29%, and random error during division accounts for 66%.
Tope modifiable causes of cancer?
Smoking Obesity Alcohol UV Inactivty Diet
What is tumor grade? What does it indicate?
Tumour grade is the degree to which tumour cells appear abnormal. Well-differentiated cells still appear fairly normal while poorly differentiated cells do not. Tumour grade indicates the aggressiveness of the tumour (how fast it will spread).
2020 overall incidence rate of cancer
225,000
4 most common cancers
Lung, breast, colorectal, prostate
Why do men have a higher chance of getting cancer in almost all cancers of organs that are shared between sexes?
Men are generally larger than women, therefore they have more cells whose division can create random errors.
The most common cancers:
Overall?
Women?
Men?
Lung
Breast
Prostate
The lifetime probability of developing cancer in men is __ and in women is ___.
50% & 45%
The lifetime probability for a woman to develop breast cancer is…
1/8
The lifetime probability for a man to develop prostate cancer is…
1/7
Mortality from cancer in 2020 is…
83,000
The cancer responsible for the most deaths in 2020 was…
Lung cancer
The lifetime probability of dying from cancer is __ in men and __ in women?
28% and 24%
The trend in incidence and mortality from cancer…
When population growth and the ageing population are accounted for, both incidence and mortality are decreasing slightly (except for incidence in women which has slightly increased).
The overall 5-year survival rate for cancer is…
63%
How many cancer survivors are currently living in Canada?
~1.7 Million
It is estimated that how many cancer survivors will be living in Canada in 2040?
~3 million
The oldest and most common treatment for cancer
Surgery
Surgery and radiation therapy are most effective for ____ cancers.
Localized
The primary treatment for a solid tumour
Surgery
Unit of measure for radiotherapy dose
Grays
Chemotherapies target
Fast growing/replicating cells
Healthy, fast growing cells often impacted by chemo
Hair follicles, GI tract cells, Mouth
How many drugs are typically included in a chemo cocktail?
2-4
Therapeutic advantage
Between doses of chemo, healthy cells are able to repair themselves and recover more than cancer cells.
Drugs that reduce the immune system’s limits, allowing it to target cancerous cells that it recognizes as its own.
Checkpoint inhibitors
Treatments that seek to eliminate the tumour
Primary therapy. Often surgery and radiation.
Treatments that reduce tumous size and spread before the primary treatment
Neoadjuvant therapies
Treatments that eliminate remaining cancer cells after primary treatment
Adjuvant
When a tumour never responds to a treatment
De novo resistance
At what grade of toxicity are cancer treatments usually altered or delayed?
Grade 3 (severe)
